喉罩麻醉在下腹部手术中的临床应用

目的:探讨喉罩麻醉在下腹部手术中的应用效果。方法:择期行下腹部手术的患者60例,ASAⅠ-Ⅲ级,随机分为喉罩组(LMA)和气管插管组(TI),每组30例;比较两组置管前后、拔管前后的SBP、DBP、HR、SpO2的变化及术后并发症的发生情况。结果:在置管前后、拔管前后,两组SBP、DBP、HR比较差异有统计学意义(P<0.05),两组SpO2比较差异无统计学意义(P>0.05);两组术后咽痛、声嘶的发生率比较差异有统计学意义(P<0.05)。结论:与气管插管麻醉相比较,喉罩麻醉具有操作简便、通气满意、应激反应小及术后并发症少的优点,值得进一步临床推广。     

Congenital anterior glottic webs with subglottic stenosis: Surgery using perichondrial keels

Four children with severe congenital anterior glottic webs required surgical reconstruction of their laryngeal airway to either avoid a tracheotomy or allow tracheotomy decannulation. The technique of re-establishing a glottic inlet allows both normal respiration, good cough and a satisfactory voice outcome. It utilizes an autogenous graft with perichondrium acting as an overlay keel to minimize glottic web reformation. All children were found to have Shprintzen syndrome.

Objective

The objective of this case series was to document the method of surgically using this perichondrial keel for airway reconstruction. It also examined the subsequent outcome and associated complications that were encountered.

Methods

A prospective analysis of four cases from 2001 to 2008 created a database of information. All cases were classified using the Cohen staging system. They were treated with the same surgical technique using auricular or costal cartilage graft with attached perichondrium, but the postoperative course was tailored to each individual case.

Results

All four children were successfully treated with removal or avoidance of a tracheostomy. All had an associated subglottic stenosis treated, and had no major complication requiring revision tracheotomy. They did not have any respiratory complications, and they produce a satisfactory voice albeit still slightly husky.

Conclusion

All four cases had Shprintzen syndrome, and confirms the need to screen for VCFS in children with an anterior glottic web. Tracheotomy is still the gold standard of treatment in severe congenital anterior glottic webs. The described technique offers another good option to the paediatric airway surgeon in managing this condition.     

咽喉反流的初步诊断

目的 探讨咽喉反流中反流症状指数量表(The reflux symptom index,RSI)和反流检查计分量表(The reflux finding score,RFS)的作用.方法 2006年8月至2008年1月来北京大学人民医院就诊的可疑有咽喉反流的患者接受RSI及RES评估,以RSI评分>13分,RES>7分定为阳性,RSI评分≤13分和RES≤7分为阴性.均行24 h双探头pH监测.以24 h内咽喉部反流次数不小于6.9次或反流面积指数(reflux area index,RAI)不小于6.3为24 h pH监测阳性.对其中25例24 h pH监测阳性且坚持抗酸治疗的患者,服药3个月后随诊,再次接受RSI和RES评分.结果 RSI及RES评估后1个量表评估阳性25例,2个量表评估均阳性16例,2个量表均阴性的15例.1个量表评估阳性和2个量表评估均阳性的结果 与24 h双探头pH监测结果 具有中度以上的一致性(一致性为73.2%,Kappa值为0.43,u值为3.48,P<0.01).当RSI和RES两个量表均阳性时与24 h pH值监测一致性更高些(一致性为77.4%,Kappa值为0.55,u值为3.06,P<0.01).抗酸治疗前后25例患者RSI和RFS评分差异有统计学意义(配对t检验,t值分别为8.838和5.695,P值均为0.000).结论 RSI和RFS两个量表可作为临床上咽喉反流初步诊断及疗效评估的简单易行方法.     

喉全切除气管造口复发癌挽救性手术治疗的相关问题探讨

术前评估和围手术期有关问题的处理.     

559例喉癌喉部分切除术的远期疗效观察

门型Ⅰ+Ⅱ期生存率为77.6%,Ⅲ+Ⅳ期生存率为72.1%.结论 正确选择术式、手术切除范围和颈清扫方式以及适当的放疗可在保证喉癌部分切除术生存率的同时促进喉功能的恢复.     

喉全切除气管造口复发癌挽救性手术治疗的相关问题探讨

s to be done on the condition that indicated candidates are properly selected, preoperative evaluations carefully conducted, and perioperative abnormal conditions unerroneously delt with.     

Expression of Epidermal Growth Factor Receptor variant III in laryngeal carcinoma tissues

Objectives

Epidermal Growth Factor Receptor variant III (EGFRvIII) has been believed to be an attractive tumor-specific candidate for molecular targeting therapy. However, there is little literature dealing with this variant of EGFR expressed in laryngeal carcinomas. In the present study, we try to evaluate the expression of EGFRvIII, as well as EGFR, in laryngeal carcinoma tissues and its correlation with clinicopathological features.

Methods

Real-time polymerase chain reaction (real-time PCR) with TaqMan probes was applied to detect the expression for EGFR and EGFRvIII mRNA in the 39 pairs of samples of laryngeal carcinoma tissues and microscopically normal laryngeal mucosal tissues adjacent to the tumor. 2^−ΔΔCT method was used to obtain the relative quantity of target mRNA expression. The correlation between EGFRvIII expression and its clinicopathological features was analyzed by Pearson's chi-squared test.

Results

Among the 39 pairs of samples of laryngeal carcinoma tissues and microscopically normal laryngeal mucosal tissues adjacent to the tumor, the level of EGFR mRNA of the former (0.030 ± 0.076) was higher than that of the latter (0.011 ± 0.046) (P < 0.01). EGFRvIII mRNA was detected only in six samples of laryngeal carcinoma tissues. While, as control, in 39 samples of microscopically normal laryngeal mucosal tissues, EGFRvIII mRNA was hardly detected. As analyzing the correlation between expression of EGFRvIII and EGFR, we found the positive rate of EGFRvIII expression was higher in samples with relative EGFR mRNA value ≥0.025 than those of EGFR mRNA <0.025. The difference between them was statistically significant (P < 0.05).

Conclusions

Expression of EGFRvIII in laryngeal carcinoma was confirmed in this study. It is tumor-specific and tends to be more frequent in EGFR-over expressing tumor tissues and poorly differentiated ones, which may in part contribute to the malignant phenotype.     

Endoscopic supraglottic laryngectomy: a proposal for a classification by the working committee on nomenclature, European Laryngological Society

In July 1999, the European Laryngological Society (ELS) has accepted a proposal for the classification of different laryngeal endoscopic cordectomies. This is actually a common classification system used as a tool for surgical training, documentation and comparison of results. The same harmonization work is deemed necessary for the treatment of supraglottic lesions. The ELS is proposing a classification of the different laryngeal endoscopic supraglottic partial laryngectomies. This classification comprises four types of supraglottic laryngectomies: Type I, limited excision of small size superficial lesions of the free edge of the epiglottis, the ary-epiglottic fold, the arytenoid, or the ventricular fold or any other part of the supraglottis; Type II, medial supraglottic laryngectomy without resection of the pre-epiglottic space, suitable for T1 lesions of either the suprahyoid or the infrahyoid laryngeal surface of the epiglottis (Type IIa, superior hemi-epiglottectomy or Type IIb, total epiglottectomy, respectively); Type III, medial supraglottic laryngectomy with resection of the pre-epiglottic space, suitable for T1–T2 tumors of the infrahyoid endolaryngeal epiglottis without (Type IIIa) or with (Type IIIb) extension to the ventricular fold, necessitating its excision; finally, Type IV, lateral supraglottic laryngectomy, suitable for tumors of the threefolds’ region, which may include the ventricular fold (Type IVa) or the arytenoid (Type IVb), when involved. As in the cases of endoscopic cordectomies, these operations are similarly classified according to the surgical approach used and the degree of resection completed in order to facilitate their use in daily clinical practice.     

The value of narrow band imaging for early detection of laryngeal cancer

We evaluate the value of laryngoscopy using narrow band imaging (NBI) system in the diagnosis of precancerous and cancerous laryngeal lesions. Thirty-four patients were suspected of having a total of 35 precancerous or cancerous laryngeal lesions among patients receiving conventional white-light laryngoscopy. All 34 patients underwent laryngoscopy with NBI system to determine whether those lesions were malignant before biopsy procedure. The diagnostic criteria of malignancy by NBI view was the presence of demarcated brownish area with scattered brown spots in the lesion. Histopathologic results were retrospectively compared with results of determination of malignancy made by NBI view. Of the 23 lesions histopathologically proved to be malignancies, 21 lesions were classified as malignant by NBI view. Sensitivity and specificity for the diagnosis of malignancy by means of NBI view compared with histopathologic results were 91.3% for sensitivity and 91.6% for specificity. NBI endoscopy seems to be a very promising diagnostic tool in the diagnosis of laryngeal malignant disease.     

Role of the αv-integrin subunit in cell proliferation,apoptosis and tumor metastasis of laryngeal and hypopharyngeal squamous cell carcinomas: a clinical and in vitro investigation

The objective of this study was to investigate the role of αv-integrin subunit (ITGAV, CD51) in invasion and metastasis of the laryngeal and hypopharyngeal squamous cell carcinomas and to evaluate whether an antisense oligonucleotide sequence (ASONs) targeting ITGAV gene can result in proliferative inhibition and induce to apoptosis of laryngeal carcinoma cell lines (Hep-2). Firstly, a tissue microarray contained 75 primary carcinomas, 29 non-cancerous normal tissues and 20 metastatic lymph nodes was constructed and used to detect the expression of ITGAV by immunohistochemistry. The changes of ITGAV expression from each group were assessed and correlated to the clinical parameters of the patients. Secondly, the ASONs targeting ITGAV gene was transfected into Hep-2 cells in vitro. The proliferative ability of the cells after transfection was measured by MTT assay and the apoptosis was detected using flow cytometry. Results showed that the expression of ITGAV was significantly correlated with differentiation and lymph node metastasis of these cancers. In vitro test showed that the proliferative ability of Hep-2 cells was significantly inhibited by ASONs in a way of concentration- and time-depending mode, and a significant apoptosis of Hep-2 cells was also observed after ASONs transfection. In conclusion, the expression of ITGAV was significantly correlated with differentiation and metastasis of the laryngeal and hypopharyngeal carcinomas; down-regulation of ITGAV gene could inhibit proliferation of Hep-2 cells and induce to its apoptosis. These results suggest that ITGAV gene may become a promising prognostic marker and new treatment target for these cancers. This study was granted by the Natural Science Foundation (D200631) and Overseas Foundation of Education Bureau (1151HZ029) of Heilongjiang Province, and Scientific Research Foundation of Harbin Bureau of Science and Technology (2006RFLXS028), P. R. China.